Peripheral Nerve Examination
J. Terrence Jose Jerome in Clinical Examination of the Hand, 2022
Ulnar nerve injuries are common and can result from a variety of mechanisms including trauma, compression neuropathy, ulnar artery aneurysms and much more. As a hand surgeon, or as a physician involved in the care of peripheral nerves, it is inevitable that you will encounter ulnar nerve pathology in your practice. Recognizing potential injury can be simple; however, there is nuance in distinguishing it from spinal cord injury or brachial plexus injury. In addition, when combined with other nerve, tendon or vascular injuries knowing the examinations specific for the ulnar nerve is vital. Furthermore, we will discuss how to better localize where the pathology is occurring. Regarding the diagnosis of compression neuropathy, a nerve conduction study in isolation is inadequate, and a good physical examination is essential [1]. The steps in a comprehensive physical examination are to carefully observe, palpate, check sensation, utilize provocative manoeuvres and perform a precise motor examination.
Nerve and Root Lesions
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
In ulnar nerve lesions, treatment is less satisfactory. If there has been acute compression or repeated external pressure, then a period of rest and careful attention to avoiding any local pressure on the nerve at the elbow may be worth a trial. This includes towel splinting the elbow in extension at night to avoid repetitive or fixed flexion when sleeping. In more severe lesions, exploration of the nerve at the elbow allows decompression if such a lesion is exposed. If this is not found, the nerve may undergo anterior transposition, resiting it more anteriorly across the elbow. Medial epicondylectomy is an alternative decompressive operation that is sometimes successful. However, such measures seldom reverse any major wasting or weakness in the small hand muscles, although pain, paraesthesiae and discomfort may be eased. In milder lesions, recovery may take place but some lesions treated conservatively may do as well. Surgical treatment may sometimes prevent further progression of ulnar nerve damage.
Diabetic Neuropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Treatments for peroneal nerve palsy include resting from any activities that worsen the condition, ice packs, anti-inflammatory medications, bracing of the ankle and foot, strengthening and stretching exercises, and surgery. Surgical procedures include peroneal nerve decompression via an incision made over the neck of the fibula. The fascia surrounding the nerves to the lateral side of the leg is released. The early surgery is performed, the better will be the recovery. Physical therapy interventions include a range of motion exercises. Other treatment methods involve cold therapy, electrical stimulation, ultrasound, and iontophoresis. Treatment of radial nerve palsy includes OTC drugs or prescription analgesics, physical therapy, splinting or casting, transcutaneous electrical nerve stimulation, and surgery to remove compressive cysts, tumors, or broken bones. Treatment of ulnar nerve palsy includes OTC analgesics, corticosteroids, splinting, physical therapy, physical therapy, and surgery.
Complications in robotic urological surgeries and how to avoid them: A systematic review
Published in Arab Journal of Urology, 2018
Rafael Rocha Tourinho-Barbosa, Marcos Tobias-Machado, Adalberto Castro-Alfaro, Gabriel Ogaya-Pinies, Xavier Cathelineau, Rafael Sanchez-Salas
Patients under general anaesthesia are at risk of nerve injuries, as they are unable to protect themselves and extreme positions further increase the risk. Position-related nerve injury risk may increase as much as 100-fold for each hour of surgery for both upper and lower limbs nerves [11,12]. Arm hyperabduction can cause brachial nerve plexus injury in the Trendelenburg position, thus it must be avoided by keeping the arms close to the body. In lateral decubitus, an axillary roll should be placed to prevent contralateral brachial plexus compression and the ipsilateral arm can be positioned on the side to avoid trauma that can be caused by robotic arm collision [12]. The ulnar nerve is typically damaged next to the elbow and patients can present with sensory and/or motor deficits. It is essential to avoid such lesions by padding the elbows. Hands should be placed in a neutral position and properly fixed to prevent radial nerve injury [12]. Femoral nerve stretch injury can result from hip hyperextension, thus one must be careful during lithotomy positioning [11]. Side docking instead of standard low lithotomic position has been proposed to overcome nerve injury of the lower limbs [13].
Evaluation of A Better Approach for Open Reduction Of Severe Gartland Type III Supracondylar Humeral Fracture
Published in Journal of Investigative Surgery, 2021
Yuxi Su, Guoxin Nan
Two patients developed ulnar nerve injury postoperatively. In these patients, the medial K-wires were removed 1 day postoperatively, and new K-wires were fixed laterally; the patients recovered after 1 month. Usually, the ulnar nerve is damaged by K-wires; hence, removal of the K-wires may help the ulnar nerve recover. All patients with preoperative radial nerve injuries recovered within 1–2 months postoperatively. One patient with a cephalic vein injury developed severe arm swelling on the second day postoperatively. By raising the affected limb, the plasters were taken off, and the swelling was relieved on the third day. Only one patient needed neurological repair. Only one patient had artery rupture, the continuity of blood vessel was still existed, but the intima of blood vessel was obviously damaged, thrombosis was formed, and blood flow was interrupted. But when we observed the blood supply of the forearm, it did not appear to be bad; hence, we ligated the vessel. It recovered well postoperatively.
Acute ulnar nerve compression associated with pisiform fracture – a case report and literature review
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Min Kai Chang, Robert Tze Jin Yap
Pisiform fractures are uncommon, with an average incidence that ranges from 0.2% to 2% of carpal fractures [5]. Due to pisiform’s proximity to the ulnar nerve in the Guyon canal, ulnar nerve palsy may occur when the pisiform fractures as a result of direct compression by fracture fragments or haematoma formation. Despite that, case reports of closed pisiform fracture that resulted in lower ulnar nerve palsy were rarely reported in literature. Due to the rarity of such cases, the management and functional outcomes are not well established. Treatment options for pisiform fracture include conservative immobilization with casting, closed reduction, open reduction with internal fixation, and pisiform excision. Pisiform excision has been shown to improve pain [3], but there have been varied reports on the functional outcomes of the wrist and ulnar nerve neuropraxia. We report a case of an acute ulnar nerve palsy as a consequence of an isolated closed pisiform fracture that was treated with pisiform excision. We also reviewed the literature on ulnar nerve recovery after the various forms of treatment options.
Related Knowledge Centers
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- Nerve
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- Little Finger
- Ring Finger
- Finger
- Nail
- Medial Epicondyle of The Humerus